Incidence of post-operative nausea and vomiting after endoscopic bariatric and metabolic therapy procedures and the role of neurokinin-1 receptor antagonists: a retrospective cohort study.

Autor: VanderWielen BA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA. vanderwielen.beth@mayo.edu., Storm AC; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA., Schroeder DR; Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA., Sprung J; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA., Weingarten TN; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Dec; Vol. 38 (12), pp. 7227-7232. Date of Electronic Publication: 2024 Oct 09.
DOI: 10.1007/s00464-024-11327-3
Abstrakt: Background: Both the transoral gastric reduction (TORe) and endoscopic sleeve gastroplasty (ESG) procedures are novel endoscopic bariatric and metabolic therapies (EBMT). Our practice has an aggressive approach to prophylaxis of postoperative nausea and vomiting (PONV) for EBMT cases, but there is divergence of practice regarding use of prophylactic neurokinin-1 receptor (NK-1) antagonists (aprepitant, fosaprepitant). Herein, we determined the incidence of PONV and its potential association with NK-1 antagonist administration following EBMT.
Methods: We identified and reviewed medical records of patients who underwent EBMT between 2018 and 2023. Patients were divided into those administered or not administered an NK-1 antagonist. We analyzed rates of PONV, which was defined as rescue antiemetics during anesthesia recovery. A propensity score was calculated, and outcomes were assessed using generalized estimating equations with inverse probability of treatment weighting (IPTW).
Results: We identified 404 patients undergoing EBMT (256 [63%] TORe, 148 [37%] ESG), and of these 253 patients developed PONV, (62.6% [95% CI: 57.9% to 67.3%]). NK-1 antagonists were administered to 119 (29.5%) patients. PONV was experienced by 42 (35%) and 211 (74%) of patients who were or were not administered an NK-1 antagonist, respectively (IPTW OR = 0.18, [95%CI: 0.10 to 0.31], P < 0.001).
Conclusions: EBMT has a high incidence of PONV during anesthesia recovery. Administration of a NK-1 antagonist as part of a multiagent PONV prophylaxis regimen dramatically reduces risk for this common adverse event.
Competing Interests: Declarations. Disclosures: Beth A. VanderWielen, M.D., Juraj Sprung, M.D., Ph.D., and Darrel R. Schroeder, M.S., have no conflicts of interest to disclose. Toby N. Weingarten, M.D., reports financial support from Medtronic, Merck, Trevena, and Takeda. Andrew C. Storm, M.D., reports research grants from Apollo Endosurgery, Boston Scientific, Endogenex, Endo-TAGSS, Enterasense, MGI Medical, OnePass, SofTac and is a consultant for Ambu, Boston Scientific, Envision Endoscopy, Intuitive, Medtronic, Microtech, Olympus.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: